Health Evolution | July 6, 2021
Ask Dale Wollschleger which career accomplishment he is the proudest of thus far and the Registered Pharmacist cuts to the chase: building a new pharmacy service model.
That new pharmacy service model, in fact, is the business of ExactCare Pharmacy, which Wollschleger founded and serves as CEO.
Health Evolution interviewed Wollschleger about always focusing on the patient first, coordinating care teams for complex patients, expanding beyond the company’s initial mental health services work, and more.
What is the origin story of ExactCare Pharmacy or the inspiration fueling the company?
Wollschleger: Way back in 2007-2008, I worked in an independent pharmacy and saw a need for more interaction with the patient by bringing pharmacy and pharmacist into the care team serving complex patients. I started with mental health by asking “how can we make these people healthier? How can we give these patients a better quality of life by enabling them to understand their medications and the importance of them?” I’m a pharmacist and I started just connecting patients with their care teams. Whether it’s case management nurses, any type of a prescriber, I really tried to interact at a higher level with them. And then I noticed that other patients were having trouble taking their medications, often because they are on so many. So I started hand filing punch cards to help the patient. At the time, that was very difficult to scale and to grow the business the way I wanted to, to be able to help more and more patients. We found some automation tools to enable adherence packaging, which we call the ExactPack, and tweaked those quite a bit to support our comprehensive clinical services model. The packaging was a big part of helping people adhere to their medication and a key component of our origin story. But the thing that really fuels executives here is the wraparound services we provide. We’re not just a pharmacy down the street where you pick up your medication. We really want to be known as the specialist to help manage a patient’s medications, just like they may have a cardiologist or endocrinologist, they truly have a pharmacist who is an active and integrated member of their healthcare team. This isn’t for everybody — it’s definitely for patients with complex, chronic medical needs.
ExactCare began by serving mental health patients. What has the company expanded into since?
Wollschleger: We started in mental health, moved into HIV and now we support patients on multiple medications across various disease states such as diabetes, high cholesterol, COPD, kidney disease, you name it. A lot of these patients have a number of challenges in managing their medications that start with simply not being able to get to a pharmacy because of transportation or mobility issues. So we started by sending what we call clinical liaisons into patient homes to go over everything and gather all their information right at the start of care. If they have a big shoebox for medications, we spend the time to review every single one with them to understand who prescribes it, how they take each medication, and how that compares with how they should be taking each medication. Just going over that with them and then solidifying what they should be taking with their prescribers is important. We figured out very quickly that they don’t always know what they should be taking or how they should be taking it, and the prescribers don’t realize that. One prescriber might prescribe something without knowing another one is prescribing a very similar medication. Drug duplications are very common among the patients we serve, and with our model, we can actively address that.
How does the company coordinate across patients’ care teams?
Wollschleger: We gather patient information and have our clinical pharmacist look it over. What we do is reach out to all the prescribers so everybody knows what medications the patient is taking. So we feel like we’re the true quarterback for the patient when it comes to all the medications. We find so much, such as drug-drug interactions because one prescriber did not have a way to know what another prescribed. It helps them understand when, say, the patient’s cardiologist should handle a specific medication instead of a primary care physician. We also educate patients about how they should be dealing with insurance companies. They might have to go into the hospital for a few days and then get discharged with all these new medications. We help coordinate all that and really become that partner to help them navigate through their health with both a pharmacist and pharmacy by their side.
You said that in the early stages it was very difficult to scale. Has it become more practical? Is it a case where innovative technology now enables you to scale?
Wollschleger: Technology has been a big piece of it. We’ve customized and built quite a bit of technology over the years that has enabled us to efficiently expand the scope of our clinical services, personalize the patient experience, support more patients, and measure outcomes. We’re growing and gaining more and more patients. We have ability to touch these patients and caregivers multiple times throughout the month. So it’s just building efficiencies through our software to enable our staff to understand a specific patient. Some of the technology we’ve built has included different apps to help patients remember to take their medication or ask questions through the apps. I would say technology is probably one of the biggest pieces to help, but the number one thing is that we always think of the patient first. Without that, we literally wouldn’t have the business. And we wouldn’t be able to grow if we didn’t have employees who understand that patient focus and help us build on it throughout our journey here.
Dale Wollschleger, ExactCare Pharmacy
We’ve talked about the technology and apps. What should our CEO readers understand about what the pharmacy solutions mean to their business?
Wollschleger: Pharmacy can have a significant impact on healthcare outcomes. We do a lot with Medicare, Medicaid, and dual populations. One of the biggest drivers for those types of plans is of course the total cost of care. Patients on our services cost less. Our goal is to keep them in their homes, keep them out of skilled care facilities, out of hospitals and really keep them healthy. One of the things we see with our patients is the total cost of care savings is significant and we improve their adherence. The other one is that a lot of plans earn bonuses based on CMS Medicare Five Star Ratings, which are impacted by medication adherence. So we help with that by enabling patients to take their medication and fill prescriptions on time.
We’ve conducted studies that have shown the results of this. One proved total savings of about $200 per member per month. Other studies have shown a range from $200 to closer to $1,000 per member per month. The variance depends on the complexity of the patient. Patients on multiple medications are more complex and there’s more opportunity for savings. These patients tend to be living with multiple chronic conditions and are taking a lot of medications. They commonly experience challenges with activities of daily living and may have lower income.
The other thing that happened about a year ago is we joined a bigger team called CarepathRx that brings multiple pharmacy care services together under one organization. The whole goal of CarepathRx is to provide an end-to-end pharmacy solution for health systems and hospitals that helps to optimize revenue and create new revenue streams. We provide care for patients from hospital to home and that creates opportunities for providers to reduce the total cost of care, reduce admissions and readmissions, which will also improve patient satisfaction. CarepathRx is really exciting not only for ExactCare but also for health systems and hospitals as we continue to grow.
There’s a lot happening in the pharmacy space right now. So from your unique purview as a pharmacist who is also an innovator, what should executives understand about the opportunities and threats in pharmacy overall right now?
Wollschleger: Elevating the role of the pharmacist is a big opportunity. If pharmacists are properly integrated into the health care team, they can have an incredible impact not only on patient health but also on measurable clinical and financial outcomes for both providers and payers. This doesn’t just relate to how a physician and pharmacist work together. It’s increasingly important for healthcare organizations to be open to innovative models that enable a collaborative and targeted approach to medication management for the people they support.
Along with that, transitions of care is another area of opportunity. Patients experience so many challenges as they transition from one care setting to another. If you think about it, medications are the only form of treatment that follow that patient through each care setting. That’s a huge opportunity to bring a level of consistency to that patient journey that not only benefits the patient but also the care providers and payers.
Recognizing that pharmacy is not a one-size-fits-all solution is also important. At ExactCare, we have designed our services to support the unique needs of people who are living with chronic conditions and who have ongoing complex medical needs. A traditional pharmacy service may be a great fit for people taking one or two medications, but the more complex a patient’s needs, the bigger the opportunity to connect them to the right kind of pharmacy support—and the more well positioned the pharmacist is to have an impact on improving that patient’s health.
Following that, what should existing and prospective customers expect moving forward?
Wollschleger: First, continued growth—with the goal of helping more patients. We’ve been growing pretty much ever since we started the company. We’re in all fifty states. And we understand there are 40 million people in need of our services. In general, we’re going to evolve as more and more patients are aging and we can help help keep them out of skilled facilities, and out of the hospital. Second, we’ll continue to expand and enhance the types of services we provide. Renal care, for example, is a new focus area for us. While we have provided support to patients with chronic kidney disease for years, we are now getting into working directly with dialysis centers. These patients have a number of specialized chronic care challenges and are in real need of support and understanding their medication.
As a CEO and founder, what career accomplishments are you most proud of?
Wollschleger: Developing a new pharmacy service model. There’s literally nothing like ExactCare. No pharmacies with people that go into the patient home to take care of people like this or that provide the level of support ExactCare does to help patients navigate the start of care process. There are different types of pharmacies out there, of course, but not like this. Next, I’d probably say joining CarepathRx because it is really going to have a big impact in hospitals and health systems. It’s exciting to be able to take something that we started in a small little mom and pop pharmacy in and grow it, and now be able to take it to a larger scale to really impact health systems and hospitals across the country and help more and more patients. And finally, focusing on the patients the way that we do—knowing that we are actively helping tens of thousands of patients nationwide every day.
And what advice would your offer other CEOs, founders and entrepreneurs?
Wollschleger: Three things. Focus on the patient, I’ve talked about patients quite a bit. Take care of every patient and everything else is going to fall into place. Yes, you have to manage the business and manage finances and all that but focusing on the patient means you have to think about how things will impact patients, what patients need, what helps and what does not and you need to determine the appropriate times and places to spend money to fix problems. That’s the first piece of advice I give. The next one is we’re in health care so don’t get too high on your highs and too low on your lows, because it’s repeatedly moving up and down as you navigate through all this. Lastly, my personal advice is to not lose sight of having fun—the work is hard, and the best teams find ways to enjoy the work while creating results for their customers.
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